Abstract 13998: Mode of Delivery and Early Outcomes in Infants with Congenital Heart Disease
Objectives: To evaluate the impact of mode of delivery (MOD) on postnatal outcome for neonates with congenital heart disease (CHD), and to assess the effect of prenatal diagnosis of CHD on perinatal management.
Hypothesis: Mode of delivery can independently influence early outcomes in infants with congenital heart disease.
Methods: We retrospectively studied all infants admitted to a single institution for cardiac intervention over a 2-year period. Infants were grouped based on having a prenatal diagnosis of CHD (yes/no) and MOD (spontaneous labor, scheduled cesarean section (C/s) or induced labor). Multivariate logistic regression was used to evaluate independent predictors for MOD and early outcomes.
Results: 45 percent of patients received a prenatal diagnosis of CHD. Those with a prenatal diagnosis were more likely to undergo an induction of labor (22% vs. 4%, p<0.001), and tended to have more scheduled C/s (39% vs. 30%, p= 0.1). A prenatal diagnosis of CHD increased the likelihood for an unnatural delivery (scheduled C/s or induction of labor) (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6 to 4.5, p<0.001). Newborns prenatally diagnosed with CHD were more likely to be delivered between 8 am and 6 pm, Monday through Friday (OR 2.3, 95% CI 1.1 to 4.8, p=0.019). There were no significant differences in APGAR score, pre-operative intubation, survival to surgery or survival to discharge based on MOD. The only independent predictor of hospital mortality was the RACHS-1 surgical mortality score.
Conclusions: While a prenatal diagnosis of CHD decreased the likelihood of spontaneous labor, the mode of delivery did not predict early outcomes in patients born with CHD.
- © 2011 by American Heart Association, Inc.